Provider Demographics
NPI:1013322080
Name:THELEMAN, CLAYTON LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:LEWIS
Last Name:THELEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:816-407-2362
Practice Address - Street 1:2521 GLENN HENDREN DR STE 108
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-3515
Practice Address - Fax:816-781-3517
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12506876208600000X
MO2019014000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery